Hi, I am Marley Hall. Here on Depression in Focus we talked about the different types of depression, now we will talk about the various forms of treatment available.
I am joined by Psychiatrist Dr. Thomas Shwartz. Dr. Shwartz, How do anti-depressants work?
They can be complicated or they can be simple. The simplest answer is they change chemical imbalances in the brain.
almost every one of our anti-depressants will raise one or more of those chemicals. And many of those depressive symptoms start to gradually get better.
When you say gradually, how long will it take?
I think some patients are fortunate and they start to get better within a few days, but the average patient, usually 4-6 weeks after being on a good antidepressant and on a good dose.
There are some people who are very opposed to anti-depressants, because of the negative side effects. What are some of the side effects if any?
Like every medication we have, there are good effects and there are side effects. Typical side effects from anti-depressants are things like headaches, stomachaches.
They are also funny, because some people get tired and some people get wired. Some people sleep better, some people sleep worse. So those are some pretty common things that we would see.
Two of the most notable side effects is people will gain weight and people will have sexual problems and those are two very difficult side effects to put up with.
And sometimes these medications make people worse before they get better, so that's also a concern.
Psychotherapy is also a very important component of seeking treatment for depression. So why is that type of talk therapy beneficial?
I think psychotherapy offers a chance to be treated without possible side effects. Psychotherapy has very few side effects compared to our medications.
I think the most common type employed would be supportive psychotherapy. Essentially, that's providing support, emotional support, cognitive support, planning support;
really trying to help people who aren't doing well, bolster their good qualities, while diminishing their difficult qualities.
After that we get into the more formal psychotherapies. Cognitive Behavioral Therapy is one form where people are trained to evaluate their thoughts, their automatic negative thoughts
and then they really combat them, in theory to reverse them. If you can change your thought patterns, your emotions tend to follow.
Another type of psychotherapy is Interpersonal Psychotherapy and the theory here is that we get depressed because we become socially disconnected.
We aren't in touch with friends, family, colleagues and one idea is to get people through these disconnections, reconnected, and the depression will go away.
Then you get into the longer term psychotherapies you see on TV. Some of these do involve lying on a couch, other ones will be sitting in chairs like this,
but this will be weekly psychotherapy, in where your psychotherapist tries to look at your past and your present and your future.
And that's a longer term psychotherapy; we call it Analytical or Dynamic Psychotherapy.
So when using talk therapy in conjunction and with the medication. How do you find the right combination?
Sometimes it's trial and error. I have heard patients suggest there is a guinea pig effect. And it's true, in some ways we don't have a scanner, we don't have a blood test,
we can't tell which medication or what psychotherapy will work. So we start with the easiest psychotherapies, the ones that are short-term often,
instead of committing people to two-three years of counseling, we try 12 weeks.
With medications, we pick the medicines with the least amount of side effects and we start there.
And if they work, I think that's a win-win situation, if they don't work or there are side effects, then you do have to change to something else.
Well, that brings us to some of the more radical treatments such as shock therapy or even surgery. When do these come into play and what are they?
We certainly have more aggressive treatments for treating depressions that are complicated, severe resistant to treatment.
These are usually reserved for patients who for many years just have not gotten better with multiple medications and different psychotherapies.
So with all these treatment options available, how do you know which one is right for you?
From a patient's point of view what I like to do is put options on the table. I think like going to a restaurant, there is a menu of things. Some things you like and some things you don't.
And so we typically offer patients medication or psychotherapy or both. And again, we meet them where they are at. We let them choose what they're most comfortable with.
Well Dr. Shwartz, thank you so much. Now that we have talked about some of the many treatment options available, next, we will talk about one very important question.
How do you go about getting treatment? How do you begin? So stay with us on Depression in focus.